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Aetiology, classification, assessment, and treatment of the anorexia-cachexia syndrome 

Aetiology, classification, assessment, and treatment of the anorexia-cachexia syndrome
Aetiology, classification, assessment, and treatment of the anorexia-cachexia syndrome

Vickie E. Baracos

, Sharon M. Watanabe

, and Kenneth C. H. Fearon

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date: 16 May 2022

Anorexia-cachexia is a heterogeneous and multifactorial syndrome most likely driven by systemic inflammation and neuroendocrine activation. Key diagnostic features include reduced appetite, weight loss, and muscle wasting. Key clinical problems include management of anorexia without resort to artificial nutritional support, and muscle wasting that cannot be completely arrested/reversed even with such intervention. Assessment should cover domains such as body stores of energy and protein, food intake, performance status, and factors resulting in excess catabolism. Intervention should be early rather than late, informed by the assessment process and focused on a multimodal approach (nutrition, exercise, and pharmacological agents). This chapter aims to discuss these issues and provide (a) the reader with some background principles to classification, (b) a simple approach to patient assessment and a robust algorithm for basic multimodal treatment, and (c) an overview of the evidence base for different pharmacological interventions.

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